Mammography Adherence and Psychological Distress Among Women at Risk for Breast Cancer

Background: Previous studies estimate that first-degree relatives of women with breast cancer have a twofold to 10-fold increased risk of developing breast cancer. Recently, attention has focused on the mammography screening practices of women who are at high risk for breast cancer. Purpose: Our pur...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 1993-07, Vol.85 (13), p.1074-1080
Main Authors: Lerman, Caryn, Daly, Mary, Sands, Colleen, Balshem, Andrew, Lustbader, Edward, Heggan, Tracy, Goldstein, Lori, James, Joan, Engstrom, Paul
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Breast cancer
Breast Neoplasms - prevention & control
Breast Neoplasms - psychology
Chi-Square Distribution
Female
Gynecology. Andrology. Obstetrics
Humans
Mammary gland diseases
Mammography
Mammography - psychology
Mammography - statistics & numerical data
Medical sciences
Middle Aged
Odds Ratio
Patient Compliance
Psychology
Stress, Psychological - etiology
Tumors
Women
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Summary:Background: Previous studies estimate that first-degree relatives of women with breast cancer have a twofold to 10-fold increased risk of developing breast cancer. Recently, attention has focused on the mammography screening practices of women who are at high risk for breast cancer. Purpose: Our purpose was to characterize mammography screening practices in a sample of first-degree relatives of breast cancer patients and to identify variables that may serve as barriers to or facilitators of adherence to mammography. Methods: Cross-sectional (rather than prospective) data were collected by telephone interviews with 140 women aged 35–79 years who had a family history of breast cancer in at least one first-degree relative (mother, sister, or daughter). Data were recorded on mammography screening patterns, depression, stress impact, and breast cancer worries. Results: Women whose mammography history adhered to age-specific recommendations varied by age: 76% of first-degree relatives aged 35–39 years, 86% aged 40–49 years, and 63% aged 50 years or more. In bivariate analyses, level of education (P & equals; .001), employment (P = .046), and time since diagnosis of the index patient (P = .044) were significantly and positively associated with mammography adherence. Variables associated negatively with adherence included age (P = .019), intrusive thoughts about breast cancer (P = .042), and breast cancer worries that interfered with daily functioning (P = .004). Multivariate analysis by logistic regression indicated that only breast cancer worries (odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.09–5.9) and education (OR = 4.8; CI = 1.6–14.3) were significant independent predictors of mammogaphy adherence. Conclusions: This study suggests that most women at high risk for breast cancer adhere to the recommended mammography screening guidelines of the National Cancer Institute. However, rates of adherence among high-risk women aged 50 years and older are suboptimal; only 63% of these women received annual screening mammograms, and 13% had never been screened. Breast cancer worries may pose a barrier to mammography adherence among high-risk women, particularly those with less formal education. Implications: Prospective longitudinal studies are needed to validate the present findings and to evaluate the impact of psychoeducational interventions for women with affected first-degree relatives. [J Natl Cancer Inst 85: 1074–1080, 1993]
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/85.13.1074